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PHYATHAI 2 INTERNATIONAL HOSPITAL

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Patient Information 1 - Healthy Heart Screening Program 2025

Title

First name

Last Name

Date of Birth

Nationality

ID card or Passport Number:

Contact Number:

Email

Patient HN (If applicable):

Appointment Date

Appointment Time


Terms and Conditions


1. You certify that the information on this payment form is complete, true and accurate.
2. Once the payment has been successfully processed, you will receive an online self-generated confirmation for your reference. If you do not receive a booking reference email, please contact us via email at onestop@phaythai.com.
3. Once your purchase is confirmed, you will receive an email confirmation with a summary of order. You can either print out your confirmation or have it digitally saved on your handheld device together with a valid passport copy on the date of visit.
4. All payments made through this online payment system is made in THB (baht), any currency conversion costs or other charges incurred in making the payment shall be borne by the payer or the patient.
5. The transaction once submitted cannot be cancelled.
6. The package can be changed to equal or greater value than the purchased. The difference must be settled prior to hospital care.
7. You will be given the receipt after the completion of service in the Hospital. The receipt will be issued in the amount of the package price you have purchased, excluding transaction fees and taxes.
8. Your transaction may not be fully completed until the bank approves your payment.
9. Phyathai 2 hospital will not be responsible if a payment is refused by the card issuer for any reason or if you do not receive the payment notification email from your card issuer. Please contact issuing bank for details as this is outside the control of Phyathai 2 Hospital.
10. Phyathai 2 Hospital reserves the rights to deny any liability for the mistaken payment because of your declaration, or because of your illegal payment.
11. For any payment inquiries, please contact us at onestop@phyathai.com or call at +662-617-2444 ext.2020, 2022, 5222

I have read and agree to the terms and conditions

Summary

ITEMS 1
THB. 3,800
TOTAL PRICE
THB. 3,800
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